Download Characteristics of Voice Disorders

Characteristics of Voice Disorders
Voice Disorder: Characterized by the abnormal
production and/or absence of vocal quality, pitch,
loudness, resonance, and/or duration, given an
individual’s age and/or sex.
Prevalence
Between 3-10% of Americans have voice disorders at any
given point in time
Classification of Voice Disorders
• Structural or Organic diseases affecting the larynx/vocal
folds
• Disorders of misuse/abuse
• Neurogenic diseases affect the parts of the central or
peripheral nervous systems involved in voice
production
• Psychogenic – no observable cause of vocal problem
Symptoms
Hoarseness –
Breathiness –
Harshness –
Tremor -
Stridor –
Glottal Fry –
Monopitch –
Uncontrolled pitch –
Diplophonia –
Aphonia –
Resonance Disorders:
I. Structural Voice Disorders:
Laryngomalacia:
• Congenital disorder resulting from lack of calcium in the
cartilages above the folds that typically resolves by 2-4
years of age.
• The aryepiglottic folds are drawn down into glottis on
inhalation
•
Voice characteristic:
Laryngeal Web:
• Thin band of connective tissue joining the two vocal
folds
• Congenital laryngeal atresia: when web completely
closes the glottis and requires immediate surgery in
order for the infant to breathe
• Congenital disorder
• Or may be the result of surgical trauma to the vocal
folds
Voice characteristics:
Papilloma:
• Benign neoplasms or wart-like growths on the
epithelium of the vocal folds
• Most likely caused human papilloma virus, although
may be hormone-related.
•
•
Voice characteristics:
Subglottic Stenosis:
• Narrowing or closing of larynx below the level of the
vocal folds.
• Etiology includes accident, surgical trauma, neoplasms,
scarring, GERD
• Symptoms may be mild to more severe
• Laser surgery to remove excess tissue or cartilage
Cricoarytenoid Joint Fixation:
• Joint becomes fixed so that it cannot rotate
• Etiologies include rheumatoid arthritis, gouty arthritis,
trauma (scar tissue)
• Can be treated with drugs:
Characteristics:
Sulcus Vocalis
• Fine longitudinal furrow or ridge along medial edge of
vocal fold
• Etiology is congenital, from trauma, or with aging
• Therapy involves vocal fold exercise or injection of
material to bulk up the fill in the ridge
Voice characteristics*Bowed folds:
Edema
• Swelling of the membranous or cover of the vocal folds
• Usually a biological response to GERD
•
Characteristics:
II. Disorders resulting from vocal abuse/misuse:
Examples: excessive loudness –yelling/screaming, hard
glottal attack, using inappropriate pitch, excessive talking,
speaking over noise, habitual coughing & throat clearing,
smoking, talking in smoky environment, etc......
Vocal Nodules
• Account for ~22% of all voice disorders
• Benign growths (usually on both folds) originating from
epithelium or cover of the vocal fold where vibration is
most vigorous
• Folds have “hour-glass” shape
• Correlation between incidence of vocal nodules and
those whose jobs rely on heavy voice use:
• Nodules can be further described as:
Early stage:
Late stage:
Voice characteristics:
Polyps
• Benign tumors of the mucosa or cover of folds
• More pliable & softer than nodules
• Can result from single abuse incident or over time or
from allergies
Voice characteristics:
Contact Ulcer
• Vocal processes on arytenoids have a very thin mucosa
that as a result is susceptible to abuse
• Often rough grainy tissue (granulation) develops around
the ulcer
• Result from abuse most often coughing/throat clearing,
speaking loudly or with very low pitches
• May be related to GE reflux:
Characteristics:
III. Neurogenic Voice Disorders:
CNS or PNS involvement
Vocal Fold Paralysis
• May be unilateral or bilateral
• May be abductor
• May be adductor
• Resulting from RLN damage- abduction & adduction
are affected, pitch control relatively intact
• Resulting from SLN damage – CT muscle is affected so
pitch control is affected
• Affected fold may atrophy (lose bulk/tone) if it is not
being innervated
• Etiology includes:
o Trauma
o Viral infection
o Neurological disease
o Damaged during surgical procedures
o Heart problems
Characteristics: )depending upon type of paralysis):
Psychogenic Voice Disorders:
• Patient complains or presents with voice symptoms that
cannot be accounted for by neurogenic, organic,
misuse/abuse disorders (e.g. puberphonia)
• Usually a psychologist becomes involved/ SLP treat
voice issue
• When to suspect a psychogenic disorder:
o Relationship between onset and stressful life
event
o Verbal communication is important in a conflict
o Vegetative throat clearing, coughing, laughter with
phonation
o Patient has a “secondary gain” by not being able
to speak it gets them out of a job or other
responsibility
Spasmodic Dysphonia
• SD is a type of dystonia involving the intrinsic muscles
of the larynx
• Exact cause of dystonias is unknown, but researchers
feel that the basal ganglia is likely involved
• SD is not very common and since symptoms can mimic
other disorders is not always correctly diagnosed
• SD is sometimes considered a psychogenic disorder,
as it is worsened by stress and is less severe or voice
may even be normal when sighing, laughing, or singing
• There are several types of SD:
o Adductor SD
Most common it occurs when muscles that
adduct the vfs contract too strongly
Voice has a strained/strangled quality with
occasional breaks when the air cannon
escape because the glottis is closed off so
tightly
o Abductor SD
Less prevalent it occurs when the abductors
or vf openers have spasms and as a result it
is difficult to adduct the folds to produce
sounds
• Mixed SD:
Affects both opening/closing of vfs
Treatment for SD